Leapfrog’s Hospital Safety Grades Show Improvement in Patient Experience and Infection Prevention

By Jay Kumar

Hospitals are seeing improvements in patient experience and a decrease in preventable healthcare-associated infections (HAI), according to The Leapfrog Group’s spring 2024 Hospital Safety Grades.

The report assigns letter grades to nearly 3,000 general hospitals on how well they prevent medical errors, accidents, and infections, and compares them to the fall 2023 Safety Grades.

“We have some good news finally on patient safety, which is that hospitals are improving on infection rates and they are improving on patient experience,” says Leah Binder, president and CEO of The Leapfrog Group. “The bad news is they’re actually really reverting to where they were prior to the pandemic, but nonetheless they had some serious shortfalls during the pandemic and they’ve recovered from those shortfalls, which is good news.”

Binder is encouraged by the current trend in the Hospital Safety Grades.

“It tells us that hospitals recognized that there were some serious problems during the pandemic and they have moved with clear energy to address those problems and they’ve succeeded,” she says. “Of course, some hospitals have done better than others as always, but we are definitely seeing progress in the right direction and now we need to see even more. They know how to improve. Let’s keep that momentum because it’s not enough to be where we were in 2019.”

In addition to grading individual hospitals, Leapfrog also reports on best patient safety performance by state and this year also added grades by metro area based on the highest percentage of A-graded hospitals. Utah received the top state ranking for the second cycle in a row. The top three metro areas are Allentown (Pennsylvania), Winston-Salem (North Carolina), and New Orleans.

Patient experience

Patient experience is measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which the Centers for Medicare and Medicaid Services (CMS) uses to publicly report patients’ perspectives of hospital care. Of the more than 30 measures used to generate the Hospital Safety Grades, The Leapfrog Group reports on five patient experience measures that directly impact patient safety outcomes:

• Nurse communication
• Physician communication
• Hospital staff responsiveness
• Communication about medicines
• Discharge information

Patient experience had worsened since the start of the pandemic in 2020. This spring’s grades show the first improvement since then, with all measures significantly improving since fall 2023. But the measures are still far from pre-pandemic levels, according to The Leapfrog Group.

“Hospitals have put a special emphasis on improving how they treat their patients and that is showing results on patient safety and patient experience,” Binder says. “In and of itself, it’s positive that patients have a good experience in the hospital. That’s enough right there. But it also turns out that when they report better experiences on these particular measures, that is correlated with their outcomes, like infections and errors and access.”

This bodes well for the future, she notes.

“This is a good indicator that we’re going to start to see even more improvements in patient safety because the culture in hospitals is clearly shifting toward the patient, and that’s what it takes to improve patient safety,” says Binder.

Focusing on the patient is also part of another market trend.

“Part of the reason that hospitals leaders have been focused on patients and really getting these results with patient experience is another trend in the market, the influence of what we call retail healthcare,” she says. “These are new players in the healthcare industry that are competing with health systems, like Walmart or Costco. These are retail establishments that have a very long history and a lot of success. It’s meeting customers where they are and being top notch at customer care, and that’s the competition now for health systems. Healthcare has not traditionally been customer-oriented, certainly not for the patient.”

Infection rates

Since Leapfrog reported its fall 2022 Hospital Safety Grades, which found HAI rates at their highest since 2016, 92% of hospitals have improved their performance on at least one of three dangerous preventable infections:

• Central line-associated bloodstream infections (CLABSI) decreased by 34%
• Catheter-associated urinary tract infections (CAUTI) decreased by 30%
• Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 30%

Binder says she felt hospitals would improve in these patient safety areas after a few down years.

“I’m an optimist so I saw the result I expected, but I will say that there was reason for concern and there is reason for optimism right now. Because not only does it tell us that hospitals have achieved improved rates of infection for instance, but it also tells us they know how to do it,” she says. “Which is another really important insight, that hospitals are aware of what it takes to improve their safety. Now they need to use that knowledge permanently, not just recovering from a public health emergency.”

“Have we made enough progress? No, we have to do so much better than we’re doing now,” she says. “It’s not even close to where we should be when you say one in four people are basically harmed when they get admitted to a hospital. That’s horrendous. There’s no industry in the country that would tolerate anything close to that level of harm.”

That said, hospitals still have a long way to go, adds Binder. It’s not so much figuring out the answers as committing your facility to complete the arduous tasks involved in improving patient safety.

“It’s really about having the will to do it,” she says. “Yes, it’s incredibly hard. I don’t want to underestimate having the will to do it and bringing and engaging your entire staff and team and board and everybody with that same will to change. I mean, that’s not easy. That’s incredibly difficult, but it’s critical and I think when you see the lives at stake and the people whose families are suffering unnecessarily, hopefully that inspires that will and that drive.”

Other patient safety concerns

Although there’s good news in the latest Hospital Safety Grades report, Binder says there are still many patient safety issues that concern her.

“There are major ones, but medication errors and medication management in general,” she says. “This is just a continuing problem and we test hospitals on how well their EMR picks up common errors or a prescriber orders a medication that would harm the patient.”

Although “we do get probably the majority of hospitals passing that test, passing is not exactly what you and I might call an ‘A’ performance. I mean, it’s more like over half the orders,” says Binder. “Now some do better than that, and some even get to 100% of the orders, though that’s rare most of the time. There’s lots of mistakes that these systems are making, so that’s concerning in and of itself that there’s not the greatest accuracy in these decision support systems that hospitals are relying on to keep patients safe. Medication order errors are the number one error made in hospitals.”

Another concern is medication reconciliation. “When you’re discharged, are you given the right instructions and given the right meds? That’s still a major problem,” she says. “Medication reconciliation is a nightmare.”

Leapfrog is hoping to recognize providers who get things right, Binder says.

“We want providers to get recognized when the patient gets better, and so anything that gets in the way of the patient getting to their optimum health status should be something that providers worry about,” she says. “But that’s not what happens. And so that’s what we end up with is this mess, which is what medication management is in many ways.”

Binder says other areas that she’s concerned about include diabetes care. When patients with diabetes are in a hospital “for all the risks they have as an inpatient, those are compounded by their diabetes,” she adds. “And it turns out that 30% of inpatients are diagnosed with diabetes, so it’s an enormous issue in hospitals and it’s an enormous issue for patient safety.”

Leapfrog has begun working with the American Diabetes Association to reward hospitals that are following the proper diabetes guidelines. “We’re just hoping to highlight when hospitals are doing the right thing and also give people with diabetes an opportunity to know who’s out there that’s paying attention to their special needs because the downside for them is amputation or worse. There are many problems that can happen beyond the normal problems they have.”